Oral Presentation Neuropathophysiology - an ISH satellite 2012

Individual differences in the cardiovascular responses to tonic muscle pain: parallel increases or decreases in muscle sympathetic nerve activity, blood pressure, and heart rate (#24)

Azharuddin Fazalbhoy 1 , Ingvars Birznieks 2 , Vaughan G Macefield 2
  1. Neuroscience Research Australia, Sydney, NSW, Australia
  2. University of Western Sydney, Penrith, NSW, Australia

We recently showed that acute muscle pain, induced by bolus intramuscular injection of hypertonic saline, causes a sustained increase in muscle sympathetic nerve activity (MSNA) and a modest increase in blood pressure and heart rate1 . However, it is not known whether long-lasting (tonic) pain - which more closely resembles chronic pain - causes a sustained increase in MSNA and blood pressure. We tested this hypothesis by recording MSNA in 12 healthy subjects. Tonic pain was induced for ~60 minutes by slow intramuscular infusion of hypertonic saline (7%) into the ipsilateral tibialis anterior muscle. Pain was sustained at a tolerable level (5-6/10 on a visual analogue scale). Seven subjects showed progressive increases in mean MSNA amplitude during tonic pain, increasing to 154 ± 17% (SEM) at 45 mins and remaining essentially constant for the duration of the infusion. In these subjects blood pressure and heart rate also increased. Conversely, for the other 5 subjects MSNA showed a progressive decline, with a peak fall of 67 ± 11% at 40 mins; blood pressure and heart rate also fell in these subjects. We conclude that tonic muscle pain has long-lasting effects on the sympathetic control of blood pressure, causing a sustained increase in some subjects yet a sustained decrease in others. This may have implications for individual differences in the cardiovascular consequences of chronic pain. Given that some patients with post-surgical chronic pain go on to develop chronic pain whereas others do not2, we believe that our results may go towards explaining why this occurs.

  1. Burton A, Birznieks I, Bolton P, Henderson L & Macefield V (2009a) Effects of deep and superficial experimentally induced acute pain on muscle sympathetic nerve activity in human subjects. J Physiol 587, 183-193.
  2. Bruehl S, Chung O, Jirjis J & Biridepalli S (2005) Prevalence of clinical hypertension in patients with chronic pain compared to nonpain general medical patients. Clin J Pain 21, 147-153.